Incorporation of Whole, Ancient Grains into a Modern Asian Indian Diet: Practical Strategies to Reduce the Burden of Chronic Disease

Nutr Rev. Author manuscript; available in PMC 2012 Aug 1.

Published in final edited form as:

Nutr Rev. 2011 Aug; 69(8): 479–488.

doi:  10.1111/j.1753-4887.2011.00411.x

PMCID: PMC3146027

NIHMSID: NIHMS302241

Anjali A. Dixit,^1,2 Kristen M. J. Azar,² Christopher D. Gardner,³ and Latha P. Palaniappan^2,4

¹ Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 W. 168^th Street, New York, NY 10032, United States

² Department of Health Policy Research, Palo Alto Medical Foundation Research Institute, 795 El Camino Real/Ames Building, Palo Alto, CA 94301, United States

³ Stanford Prevention Research Center, Stanford University, Hoover Pavilion, Room 403; 211 Quarry Road, Stanford, CA 94305, United States

⁴ Department of Health Research & Policy, HRP Redwood Building, Stanford University School of Medicine, Stanford, CA 94305, United States

Address correspondence and reprint requests to: Latha Palaniappan, M.D., M.S., Palo Alto Medical Foundation Research Institute, 795 El Camino Real/Ames Building, Palo Alto, CA 94301, Telephone: (650) 853-4752, Fax: (650) 329-9114, Email: gro.irfmap@pahtal

Author information ▼ Copyright and License information ►

The publisher's final edited version of this article is available at Nutr Rev

See other articles in PMC that cite the published article.

Go to:

Abstract

Refined carbohydrates, such as white rice and white flour, are the mainstay of the modern Asian Indian diet, and may contribute to the rising incidence of type 2 diabetes and cardiovascular disease in this population. Prior to the 1950s, whole grains such as amaranth, barley, brown rice, millet, and sorghum were more commonly used in Asian Indian cooking. These grains and other non-Indian grains such as couscous, quinoa, and spelt are nutritionally advantageous and may be culturally acceptable carbohydrate substitutes for Asian Indians. This review focuses on practical recommendations for culturally sensitive carbohydrate modification in a modern Asian Indian diet, in an effort to reduce type 2 diabetes and cardiovascular disease in this population.

Keywords: Asian Indian, whole grain, nutrition, diet, chronic disease

Go to:

INTRODUCTION

Asian Indians and Asian Indian immigrants to the United States (U.S.) face a distinct transition in nutrition and dietary practices. Immigration is generally associated with higher caloric intake¹ and higher intake of refined and processed grains²; less physical activity³; and consequent weight gain.¹ Nutrition counseling should initially target reduction in caloric excess, reduction of refined, processed grains and added sugars, and include other interventions to promote weight loss and reduce disease burden.

Despite normal weight, Asian Indians are at higher risk for type 2 diabetes and other metabolic abnormalities. ^4–11 The modern Asian Indian diet is particularly high in refined carbohydrates and low in protein, when compared to other dietary traditions.^12–13 Recent studies in India have established strong positive associations between refined grain intake and type 2 diabetes, and confirm the protective effect of fiber, which is contained in whole grains.¹⁴ Observational studies have shown that whole grains^15–18 are associated with weight loss, reduced insulin resistance and type 2 diabetes. Carbohydrates are integral to Asian Indian dietary traditions,¹⁹ and re-introduction of culturally acceptable, traditional, carbohydrate-rich grains with high nutrient density may be a prudent step in reducing disease burden in this population.

Since the 1951 Green Revolution in India, refined grains such as white rice and refined wheat flour have become staples of the modern Asian Indian diet.¹⁹ The Green Revolution was an attempt by the Indian government to avoid reliance on foreign food aid (following independence from British imperialism) by developing and subsidizing inexpensive, high-yield crops.¹⁹ Prior to this nutrition transition in India, traditional meals and recipes were derived from whole grain carbohydrates¹⁴ and included amaranth, barley, millet and other ancient grains that have been grown on the Indian subcontinent for the past few millennia.

This paper seeks to review and provide recommendations on employing various ancient, whole grains as a preferred carbohydrate source in a modern Asian Indian diet—particularly an immigrant diet—to achieve a balance of macronutrients, micronutrients, fibers, and phytochemicals for optimal health promotion and in order to prevent chronic diseases such as type 2 diabetes, cardiovascular disease (CVD), and obesity. Use of these grains may also allow individuals to make healthful dietary changes that align with cultural tradition, because Asian Indians place particularly high value on traditional diets and may feel more comfortable modifying their traditional diets rather than adopting a new, more Western diet altogether.²⁰ Providing more healthful and traditional whole grain substitutes for refined carbohydrates can be thought of as one important aspect of therapeutic dietary modification. Asian Indian immigrants in the United States and their healthcare providers can collaboratively use this information to achieve better health outcomes. These recommendations can also be extrapolated and tailored to other Asian Indian diaspora populations around the world; similar approaches to culturally sensitive recommendations for lifestyle and diet modification may be appropriate in other racial/ethnic groups in different regions of the world as well.